♪ ♪ ♪ ♪ HOW MANY DOCTORS DOES MAMA HAVE AND WHO IS IN CHARGE?

THAT'S A QUESTION THAT AFFECTS HEALTH OUTCOMES AND COST.

STAY WITH US AS WE TALK ABOUT TRUE PATIENT CENTERED CARE FOR THE SENIOR SET WITH Dr. MISHA RHODES NEXT ON KENTUCKY HEALTH.

A COMEDIAN WHOSE NAME I CANNOT RECALL SAID THAT WHEN HE WAS KNEW THAT THE PAIN WOULD BE GONE IN A DAY BUT THAT SINCE TURNING 40, HE KNEW THE PAIN WOULD BE WITH HIM THE REST OF HIS LIFE.

I DON'T KNOW ABOUT YOU BUT FOR ME THERE IS MORE TRUTH THAN HUME OOR IN THAT STORY.

WE ARE AN AGING SOCIETY.

THE OLDER WE GET, THE MORE LIKELY IT IS THAT WE WILL ACCUMULATE MULTIPLE AILMENTS.

MOST WILL BE MINOR BUT SOME WILL BE SERIOUS.

WE WILL ALSO ACCUMULATE MULTIPLE HEALTHCARE PROVIDERS TO TEND TO THOSE AILMENTS.

WHILE WE WILL ALL HOPE AND ASSUME THAT OUR TEAM OF PROVIDERS ARE COMMUNICATING AND COORDINATE WITH ONE ANOTHER, PARTICULARLY AS THIS RELATES TO MEDICATIONS, THIS IS UNLIKELY.

IN FOOTBALL, IT IS ARGUED THAT THE MOST IMPORTANT PLAYER ON THE FOOTBALL TEAM IS THE QUARTERBACK.

THIS IS THE ONE PLAYER WHO KNOWS WHAT EVERYONE ELSE ON THE TEAM IS DOING AND CALLS THE PLAY: THOUGH IT WOULD BE NICE TO HAVE A TOM BRADY ON YOUR TEAM AS A HEALTHCARE TEAM LEADER, WE CAN DO ONE BETTER.

THERE IS A NEW HEALTHCARE TEAM CONCEPT FOR CARING FOR THE OLDER SET, FOCUSED SENIOR CARE.

AND I THINK THAT THIS IS THE TYPE OF CARE FOR WHICH MANY OF US HAVE BEEN SEARCHING FOR FOR OURSELVES AND FOR OUR FAMILY MEMBERS.

TO TALK MORE ABOUT THIS CONCEPT, WE HAVE AS OUR GUEST Dr. MISHA RHODES.

Dr. RHODES IS A GRADUATE OF THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE AND DID HER RESIDENCY IN INTERNAL MEDICINE AT THE UNIVERSITY OF MICHIGAN HEALTH SYSTEM.

SHE HAS PRACTICED IN JUST ABOUT EVERY PRACTICE MODEL THERE IS.

ACADEMIC MEDICAL CENTERS, MANAGED CARE PROGRAM, WAS AN EMPLOYED PHYSICIAN AND HAD HER OWN INDEPENDENT PHYSICIAN PRACTICE.

CURRENTLY, AND GERM AINTO TODAY'S DISCUSSION, HE SENIOR PRIMARY CARE IN KENTUCKY AND INDIANA.

>> THANKS FOR HAVING ME.

GLAD TO BE HERE.

>> YOU HAVE DONE A LOT IN A SHORT PERIOD OF TIME.

>> I HAVE.

IT'S BEEN A VERY INTERESTING LIFE JOURNEY SO FAR.

>> I'M GLAD THAT YOU WERE ABLE TO TAKE SOME TIME OUT AND BE HERE WITH US TODAY.

WHEN TALKING TO YOU, SOMETIME AGO, I THINK IT IS WHAT HELPED GET OW TO THIS SHOW AND I'M GREAT GRATEFUL THAT YOU ARE.

YOU TALKED ABOUT OPRAH LEVEL CARE.

TELL ME WHAT DO YOU MEAN BY THAT?

>> SO ONE OF OUR PHYSICIANS, Dr. TIMIA EVANS, WHO IS OUR LEAD PHYSICIAN AT THE WEST LOUISVILLE CENTER WAS ON THE LOUISVILLE URBAN LEAGUE PODCAST WITH LYNDON PRYOR AND IT WAS THERE THAT HE SAID THIS SOUNDS TO ME LIKE OPRAH LEVEL CARE WHEN SHE WAS DESCRIBING OUR CARE MODEL.

AND IT REALLY STUCK.

IT RESONATED.

AND WE WERE ALL HEAD NODDING AND SAYING YES.

HE SAID IT WAS THE KIND OF CARE THAT EVERYBODY DESERVED, NOT JUST PEOPLE WHO HAD A LOT OF WEALTH: EVERYBODY DESERVED THAT SAME LEVEL OF CARE.

>> WHEN WE THINK ABOUT THE DIFFERENT TYPES OF PRACTICES AND YOU HAVE BEEN THROUGH ALL OF THEM, TAKE ME THROUGH.

WHAT ARE THE KINDS OF THINGS THAT ARE OUT THERE FOR US?

>> SO WITH THE WAY I LOOK AT IT, PRIMARY CARE RIGHT NOW IS A ONE SIZE FITS ALL.

EXCEPT FOR THOSE VERY YOUNG.

WE CARVE OUT PEDIATRICS FOR THEM AND WE SAY BECAUSE YOU ARE VERY YOUNG, WE KNOW YOU HAVE DIFFERENT NEEDS THAN THE REST OF US.

SO WE ARE GOING TO GIVE YOU A SEPARATE LEVEL OF CARE.

FOR THOSE OF US, ONCE WE AGE OUT OF PEDIATRICS, WHETHER 16 OR 18 AND THEN YOU HAD ON THROUGH REST OF YOUR LIFE, IT'S THE SAME FOR EVERYBODY.

YOU GET THE SAME AMOUNT OF TIME WITH YOUR PROVIDERS, YOU GET THE SAME ISSUES ADDRESSED.

AND FOR THE MOST PART, IT'S FAIRLY TRANSACTIONAL.

WHEN I'M SICK, I GO IN.

THERE IS NOT A LOT OF PREVENTATIVE TIME SPENT TO TRY TO KEEP PEOPLE HEALTHY.

AND SO WHEN WE LOOK AT SENIORS, AND AS YOU WERE SAYING BEFORE, MORE OF US ARE GETTING OLDER WHILE AGING, MYSELF INCLUDED, AND YOUR NEEDS CHANGE.

YOUR NEEDS CHANGE.

AND YOUR HEALTHCARE SHOULD ADJUST TO MATCH THOSE NEEDS, WHETHER IT'S MORE TIME SPENT WITH YOUR DOCTOR, YOU KNOW, OR JUST LOOKING AT MORE PREVENTATIVE MEASURES BUT YOU NEED THAT.

>> WHEN YOU TALK ABOUT MORE TIME TO SPEND WITH YOUR DOCTOR AND YOU REFER TO THE OPRAH LEVEL CARE, WHEN WE GO TO THE ONE ON ONE WITH OUR PRIMARY CARE PROVIDER, THERE IS A LIMITED AMOUNT OF TIME THAT'S AVAILABLE THERE.

>> RIGHT.

RIGHT.

FOR MOST TRADITIONAL PRIMARY CARE PRACTICES THESE DAYS, YOU MAY HAVE 10 TO 15 MINUTE APPOINTMENTS.

BY THE TIME YOU ACTUALLY GET INTO THE ROOM AS A PROVIDER, SEE THE PATIENT, THAT TIME IS CUT EVEN FURTHER SHORT.

AND YOU HEAR PATIENTS SAY, I DIDN'T GET A CHANCE TO REALLY TALK ABOUT WHAT I WANTED TO TALK ABOUT.

I DIDN'T REALLY SEE MY PROVIDER FOR VERY LONG.

AND I THINK WHAT WE HAVE DONE WITH THE CENTER WELL MODEL, WHICH IS A VALUE-BASED CARE MODEL AND WE CAN GO INTO THAT FURTHER, BUT IS TO SAY, YOU NEED MORE TIME.

IT TAKES TIME FOR ME TO TRULY TREAT YOU AND TO ACHIEVE THE OUTCOMES THAT BOTH THE PATIENTS AND THE PROVIDER ARE LOOKING TO HAVE AND YOU CANNOT DO THAT IN 10 TO 15 MINUTES.

>> ALONG CAME THE CONCEPT OF CONCIERGE MEDICINE WHERE PEOPLE WITH A GREAT DEAL OF MONEY CAN GET CARE.

HOW DOES THAT FIT INTO THE MODEL?

>> IF YOU ARE A PATIENT, YOU CAN BUY UP ALMOST, TO CONCIERGE LEVEL CARE WHERE HAVE YOU THE 45 MINUTES OR MORE TO SPEND WITH YOUR DOCTOR.

YOU CAN COME IN AS OFTEN AS YOU WANT TO.

THERE ARE CERTAIN PRIVILEGES THAT ARE GIVEN TO YOU FOR THAT.

AND WHAT WE HAVE SEEN AT CENTER WELL IS, YOU DON'T HAVE TO PAY FOR THAT.

YOU DON'T HAVE TO PAY EXTRA FOR THAT.

IF YOU ARE A SENIOR OR YOU HAVE MEDICARE AS YOUR PRIMARY PAYER, COME INTO THE DOOR, YOU HAVE 45 MINUTES TO AN HOUR WITH US AS A NEW PATIENT OFF THE BAT.

THERE IS NO ADDITIONAL CHARGE NECESSARY FOR THAT.

>> SO THEN, THE IDEA OF THE PHYSICIAN MAKING MONEY IS SOMETHING-- AND I'M NOT USING THAT IN THE PEJORATIVE NEGATIVE SENSE.

IT'S A BUSINESS AT THE END OF THE DAY,.

>> YES.

>> BUT WE DO A FEE-FOR-SERVICE TYPE OF THING.

DESCRIBE THAT TO ME.

>> FEE-FOR-SERVICE IS ALMOST COME BACK AND SAY EXACTLY WHAT IT MEANS.

YOU, AS A PATIENT, I'M PAYING A FEE FOR YOU AS A CLINICIANS TO PROVIDE ME A SERVICE.

SO I COME IN THE DOOR.

I SAY MY KNEE HURTS I GET TAKEN BACK INTO A ROOM AND I GO BACK TO THE ROOM AND YOU GIVE ME A PRESCRIPTION AND IT IS VERY TRANSACTIONAL.

IT IS TRANSACTIONAL RELATIONSHIP.

THAT'S HOW MOST PRIMARY CARE IS THESE DAYS.

>> IS IT A CONCERN THAT THE PHYSICIAN IS GOING TO DO SOMETHING BECAUSE THE MORE THEY DO, THE MORE THEY GET PAID?

>> NOT NECESSARILY.

NOT FOR PRIMARY KAY-- NOT FOR PRIMARY CARE.

IT'S MORE ABOUT HOW MANY PEOPLE CAN I SEE IN A DAY.

SO IT'S ABOUT VOLUME AND FEE-FOR-SERVICE.

>> YOU USED THE TERM VALUE-BASED.

SO WHAT IS THAT AND HOW DOES THAT DIFFER FROM FEE-FOR-SERVICE.

>> VALUE BASED IS IN SIMPLISTIC TERMS, BASED ON YOUR OUTCOMES.

IT'S ABOUT QUALITY VERSUS QUANTITY, WHICH IS HOW I COMPARE THE TWO.

SO FEE-FOR-SERVICE IS ABOUT HOW MANY PATIENTS CAN I SEE IN A DAY TO BE ABLE TO MEET MY QUOTE QUOTAS OR MAKE MY BUSINESS NEEDS AND WITH VALUE-BASED CARE, IT'S ABOUT WHAT IS THE ACTUAL QUALITY.

ARE YOU WE HAVING THE OUTCOMES WE NEED TO HAVE, ARE WE KEEPING PATIENTS OUT OF THE HOSPITAL, ARE WE KEEPING THEM HEALTHY?

ARE THEY STAYING AT HOME AND HAVING A BETTER QUALITY OF LIFE OVERALL?

>> ARE YOU SUGGESTING THAT IN THE FEE-FOR-SERVICE MODEL, I COME IN AS A DIABETIC PATIENT, WHETHER MY DIABETES IS CONTROLLED OR HAVE COMPLICATIONS FROM THE DIABETES, THE PHYSICIAN GETS PAID.

WHEREAS IN THE VALUE-BASED MODEL, IF MY DIABETES ISN'T CONTROLLED, YOU ARE DINGED FOR THAT?

>> YOU COULD BE.

THERE IS A WAY.

SO THERE ARE QUALITY MEASURES THAT THE GOVERNMENT SETS UP FOR EVERYBODY, ALL PHYSICIANS, TO TRY TO ATTAIN FOR THEIR PATIENTS BECAUSE WE KNOW THIS IS EVIDENCE-BASED MEDICINE.

WE KNOW IF YOU ARE A DIABETIC AND YOUR A1C IS LESS THAN, YOU ARE GOING TO HAVE BETTER OUTCOMES.

YOU ARE GOING TO DO BETTER.

AS PRACTICING PHYSICIANS, WE SHOULD ALL BE TRYING TO GET THERE BUT SOMETIMES YOU JUST DON'T HAVE THE TIME TO DO IT.

YOU NEED THE TIME TO DO IT THE EDUCATION THAT'S NECESSARY TO GET TO THE OUTCOME THAT YOU ARE LOOKING FOR FOR THE PATIENT.

>> IS WHAT IS BEING DONE OVER AT CENTER WELL, IS THAT A VALUE BASED PROGRAM?

>> IT IS.

>> WHAT ARE THE BENEFITS AND GOALS OF A VALUE-BASED CARE MODEL?

>> ONCE AGAIN IT'S ABOUT HAVING THOSE QUALITY OUTCOMES, KEEPING PATIENTS HEALTHY, KEEPING THEM OUT OF THE EMERGENCY ROOM AND URGENT CARE, MAKING ACCESS AVAILABLE FOR PATIENTS TO PRIMARY CARE SO THAT YOU COME AND UTILIZE PRIMARY CARE WHETHER IT'S AN ACUTE ILLNESS OR WHETHER YOU ARE COMING IN FOR A ROUTINE FOLLOW-UP.

>> SO, BECAUSE HEALTHCARE IS A BUSINESS, WHAT IS THE FINANCIAL INCENTIVE FOR SOMEONE TO PARTICIPATE IN THAT FROM THE PROVIDER SIDE?

>> FROM THE PROVIDER SIDE.

SO I WOULD SAY THE SIMPLEST WAY TO PUT IT IS YOU ARE REWARDED IF THE PATIENT DOES WELL.

THAT'S THE MOST SIMPLISTIC WAY I CAN PUT IT.

THERE ARE CONTRACTS THAT CAN BE BROKERED BETWEEN PAIR PAYERS AND DIRECTLY WITH CMS.

BUT AT THE END OF THE DAY, IF THE PATIENTS DO WELL AND YOU ARE ABLE TO ADDRESS THE QUALITY, THE EVIDENCE-BASED QUALITY MEASURES THAT WE KNOW AFFECT HEALTH OUTCOMES, THEN YOU ARE REWARDED FOR THAT.

>> YOU SAID CMS.

WHAT IS THAT?

>> CENTERS FOR MEDICARE AND MEDICAID SERVICES.

>> IT'S NOT CMMS.

>> IT SHOULD BE, YES.

[LAUGHTER] >> ARE THEY THE ONLY ONES DETERMINING WHAT THE OUTCOME MEASURES ARE OR DO THE VARIOUS INSURERS HAVE A STAKE IN THIS?

>> YOU KNOW, THAT'S A LOADED QUESTION.

I'LL SAY THAT FOR THE MOST PART, IT IS COMING DOWN FROM THE FEDERAL LEVEL.

I THINK THAT SOME INSURERS MAY ADD-- AND IT DEPENDS ON THE CONTRACTS, SO IT CAN GET VERY SPECIFIC AND VERY DETAIL ORIENTED FOR THE MOST PART ALL INSURERS ARE GOING TO FOLLOW WHATEVER THE FEDERAL GUIDELINES ARE.

>> SO WITH THIS MODEL, AS YOU DESCRIBED IT, A LOT IS DEPENDENT UPON THE PATIENT.

SO WHAT ARE THE EXPECTATIONS FOR THE PATIENT, BOTH FROM THE PROVIDERS AND WHAT DO YOU EXPECT FROM THE PATIENT AS THE PERSON WHO IS TAKING CARE OF THIS PERSON?

>> FOR PATIENTS I FIND THAT IT'S A LITTLE BIT OF A MIND SHIFT FOR THEM.

A LOT OF PATIENTS ARE VERY USED TO COMING IN ONLY WHEN I'M SICK AND WHAT WE ARE HAVING TO EDUCATE PATIENTS ON IS WE WANT TO SEE YOU MORE FREQUENTLY.

WE DON'T WANT TO SEE YOU JUST WHEN YOU ARE SICK BECAUSE BY THE TIME YOU GET SICK, WE MAY BE TOO FAR BEHIND TO BE ABLE TO REALLY MAKE AN IMPACT.

SO WE WANT TO KEEP YOU WELL, WHICH MEANS WE NEED TO SEE YOU A LITTLE MORE OFTEN THROUGHOUT THE YEAR THAN ONLY WHEN YOU ARE ILL. >> BUT THERE IS A COST THERE, ISN'T THERE?

>> NO.

>> THERE IS NO COST?

>> NOT FOR MOST.

>> YOU USE THE PEDIATRIC MODEL IN THE BEGINNING SO WE KNOW WITH PEDIATRICS THERE IS THE WELL BABY.

FOR LACK OF A BETTER TERM, THIS IS THE WELL GRANNY VISIT.

>> AN ANNUAL WELLNESS VISIT.

>> WE WON'T SAY WELL GRANNY THEN.

[LAUGHTER] WHAT'S THE DOWNSIDE FOR PROVIDERS TO BE PARTICIPANTS IN A PROGRAM LIKE THIS?

>> THERE IS AN ADJUSTMENT.

THERE IS AN ADJUSTMENT PERIOD FOR SURE.

AND I THINK THE MAIN THING THAT I HEAR IS THE DOCUMENTATION.

THERE IS SOMETHING THAT I TURN DOCUMENTATION TO SPECIFICITY.

I DIDN'T TERM IT BUT THAT'S WHAT I CALL IT.

AND IT BASICALLY GOES BACK TO REMEMBERING WHEN YOU WERE IN MEDICAL SCHOOL AND YOU WOULD WRITE PAGE-- FOR THOSE OF US WHO REMEMBER PAPER AND PENCIL.

>> I USED A STONE TABLET BUT GO AHEAD.

>> BUT WRITING ALL THAT OUT AND COULD YOU HAVE TWO OR THREE PAGES OF YOUR NOTES.

AND YOU GET BACK TO BY THE TIME YOU ARE OUT OF RESIDENCY, IT'S I GOT TO BE FAST, I GOT TO BE FAST SO YOU DON'T DOCUMENT AS WELL.

I MEAN THIS IS PROVEN.

SO WHAT WE ARE ASKING PHYSICIANS TO DO IS TO DOCUMENT A LITTLE MORE.

IT DOESN'T HAVE TO BE THREE PAGES OF NOTES.

BUT TO DOCUMENT SPECIFICALLY HOW WELL OR HOW ILL YOUR PATIENT IS.

I LIKE TO SAY IT'S TELLING THE PATIENT STORY.

IF YOU WERE WRITING A BOOK, YOU WANT TO HAVE IT AS COMPLETE A POSSIBLE.

>> GOTCHA.

YOU ARE THE DIRECTOR AT CENTER WELL IN KENTUCKY AND INDIANA.

WHAT IS CENTER WELL?

>> CENTER WELL IS AN ENTITY THAT INCORPORATES OUR SENIOR PRIMARY CARE ORGANIZATION AS WELL AS OUR HOME HEALTH HORGS ORGANIZATION AND PHARMACY ALL FALLING UNDER THE CENTER WELL UMBRELLA.

I'M PART OF THE PRIMARY CARE ORGANIZATION WHICH IS SENIOR PRIMARY CARE.

>> GOTCHA.

MULTIPLE LOCATIONS?

>> MULTIPLE LOCATIONS THROUGHOUT THE COUNTRY.

I THINK BY THE END OF THIS YEAR, WE SHOULD BE IN 15 STATES, 260 PLUS CENTERS.

>> SO WHO IS BEING SERVED BY THIS?

>> SENIORS.

SO OUR AVERAGE, AVERAGE POPULATION 65 AND OLDER, ALTHOUGH I WILL SAY THAT ANYONE WHO HAS MEDICARE AS THEIR PRIMARY PAYER SOURCE, WE WILL SEE.

>> BUT HAVE YOU TO BE A SENIOR AND BECAUSE MEDICARE COVERS SOME PEOPLE WHO ARE NOT SENIORS.

>> WE WILL SEE THEM.

>> AND WILL YOU SEE THOSE PEOPLE, TOO.

>> YES, SIR.

>> ARE YOU TAKING ALL COMERS, NO MATTER PREEXISTING CONDITIONS AND THINGS LIKE THIS?

>> YES, SIR.

WE TAKE ALL OF THE MAJOR HEALTH PLANS IN THE AREA.

SO WE ARE PAYER AGNOSTIC MEANING WHETHER YOU HAVE ANTHEM, HUMANA, WELL CARE, UNITED, YOU CAN COME TO US.

>> MEDICARE IS THE PRIMARY INSURANCE... >> IT CAN BE ORIGINAL MEDICARE OR MEDICARE ADVANTAGE PLANS.

>> TELL ME THE DIFFERENCE BETWEEN MEDICARE AND MEDICARE ADVANTAGE BECAUSE I GET CONFUSED BY THAT.

WHEN I SEE THAT ON TV ALL THE TIME.

>> ORIGINAL MEDICARE IS COMING AND FUNDED THROUGH THE GOVERNMENT.

AND AS A PATIENT, YOU ARE DIRECTLY HAVING THEM AS YOUR PAYER SOURCE, RIGHT?

AND YOU HAVE PART A, PART B, PART D WHICH IS THE PHARMACY SPEND, PART B WHICH IS YOUR PRIMARY CARE, PART A IS YOUR INPATIENT.

MEDICARE ADVANTAGE, WHICH ALWAYS CONFUSES A LOT OF US IS PART C. SO MEDICARE ADVANTAGE IS REALLY PART C AND SO WHAT HAPPENS IS THERE IS AN ALIGNMENT BETWEEN THE GOVERNMENT AS WELL AS SOME OF THE BIGGER INSURERS AND THEN THEY WILL ADMINISTER THE BENEFITS.

>> SO I'M DEALING DIRECTLY THROUGH THE GOVERNMENT IF I HAD MEDICARE AND IF I HAVE ADVANTAGE, I'M GOING THROUGH A PLAN.

SO JUST OUT OF CURIOSITY, DOES IT BEHOOVE ME ONE WAY OR THE OTHER TO HAVE MEDICARE ADVANTAGE OR MEDICARE IF I WANT INTO A PROGRAM LIKE YOURS?

>> FOR US, NO.

I SAY EVERYBODY IS INDIVIDUAL AND IT DEPENDS ON WHAT YOUR NEEDS ARE.

AND SO FOR SOME PATIENTS, IT MAKES SENSE FOR THEM TO HAVE ORIGINAL MEDICARE.

FOR OTHER PATIENTS, IT MAKES SENSE FOR THEM TO HAVE A MEDICARE ADVANTAGE PLAN.

IT'S REALLY PERSON DEPENDENT.

>> YOU TALKED ABOUT THE DIFFERENT ENTITIES.

IT SOUNDS LIKE THIS IS A WHOLE TEAM.

>> INTEGRATED.

>> SO TELL ME, AGAIN, GO THROUGH WHO THE MEMBERS OF THE TEAM.

>> FOR OUR TEAM, WITHIN PRIMARY CARE, WE HAVE OUR PHYSICIAN, OUR NURSE PRACTITIONER WHICH WILL BE AT EVERY CENTER.

WITHIN THE CENTER THEY WILL HAVE SUPPORT FROM A SOCIAL WORKER, BEHAVIORAL HEALTH SPECIALIST, WILL HAVE AN RN WHO HELPS DO A LOT OF EDUCATION AROUND CHRONIC DISEASE ILLNESS.

AND THEN, OF COURSE, WE HAVE OUR WONDERFUL MEDICAL ASSISTANTS, FRONT OFFICE STAFF AND CENTER ADMINISTRATORS.

>> WHAT ABOUT SPECIALTY CARE AND REHABILITATION SERVICES.

ARE THEY INCLUDED, TOO?

>> THEY'RE NOT NECESSARILY PART OF THE TEAM.

WE WILL REFER OUT AS WE NEED TO FOR PATIENTS AND WE DO PROVIDE TRANSPORTATION FOR PATIENTS TO AND FROM OUR CENTERS FOR SURE.

AND ALSO, YOU KNOW, DEPENDING ON WHAT IS GOING ON WITH SPECIALTY CARE, BUT WE TRY NOT TO LET THOSE SOCIAL DETERMINANTS OF HEALTH BE A BARRIER TO SOMEONE'S HEALTH OUTCOMES.

>> NOW, BECAUSE YOU ARE JUDGED, AS MANY PHYSICIANS NOW ARE ALSO BEING JUDGED, BY THE OUTCOMES THAT WE GET, I ALLUDED TO THIS EARLIER, THOUGH, IT IS VERY IMPORTANT THAT PATIENT ALSO HAVE BUY-IN.

WHAT DO YOU DO TO HELP ENCOURAGE THE PATIENT TO BUY INTO WHAT YOU ARE DOING.

HOW DO YOU FIT THIS WHOLE THING?

>> I THINK IT STARTS WITH EDUCATION.

WE WERE TALKING ABOUT THAT BEFORE.

EDUCATION, NOT ONLY ON CENTER WELL AND HOW WE OPERATE AS THE PRIMARY CARE OFFICE, WHICH IS VASTLY DIFFERENT FROM TRADITIONAL, BUT THEN EDUCATING PATIENCES WHAT CAN HAPPEN IF WE DON'T KEEP YOU WELL, WHAT CAN HAPPEN IF WE DON'T CONTROL YOUR BLOOD PRESSURE OR DON'T MANAGE YOUR HEART FAILURE FOR CHRONIC PULMONARY OBSTRUCTIVE DISEASE.

WHAT CAN HAPPEN AND MAKING SURE PATIENTS HAVE EDUCATION.

AND INFORMATION.

INFORMATION IS KEY AND EDUCATION IS KEY.

YOU HAVE TO HAVE THE TIME TO DO IT.

IT DOESN'T HAPPEN IN ONE VISIT.

>> SO YOU HAVE INDIVIDUALS WHO WILL SPEND TIME TALKING TO THE PATIENT ABOUT WHAT IS GOING ON AND EDUCATING SNEM.

>> SO OUR CARE COACH, WHO IS A NURSE WILL DO THAT.

SHE WILL SPEND TIME TALKING TO OUR PATIENTS WHO ARE DIABETIC ABOUT HOW TO MONITOR THEIR BLOOD SUGARS, WHAT FOODS TO EAT SO NUTRITION COUNSELING THERE.

SHE WILL TALK TO OUR HEART FAILURE PATIENTS ABOUT YOU NEED TO WEIGH YOURSELF EVERY MORNING.

IF THIS, THEN WE WANT TO YOU DO THIS.

BUT ALSO, I COMMEND OUR NURSES NURSE PRACTITIONERS AND PHYSICIANS BECAUSE THEY SPEND A LOT OF TIME EDUCATING THEIR PATIENTS.

>> YOU ALLUDED TO IT BEFORE, TYPICAL PRIVATE PRACTICE MODEL, THERE IS ABOUT 15 MINUTES PLUS OR MINUS IN WHICH TO TALK TO THE PATIENT.

HOW BIG ARE THE PANELS THAT YOUR PROVIDERS CARRY AND HOW MUCH TIME ARE THEY ALLOTTED TO SPEND WITH THE PATIENT?

>> SO IN GENERAL, NURSE PRACTITIONER/PHYSICIAN COMBINED WILL HAVE 750 PATIENTS ON THEIR PANELS, COULD BE A LITTLE MORE, COULD BE A LITTLE LESS.

AND FOR NEW PATIENTS, THEY WILL SPEND 45 MINUTES TO AN HOUR WITH THEM ON AVERAGE.

AND THEN FOLLOW-UP VISITS CAN BE 20 MINUTES, 30 MINUTES IF THEY NEED TO BE.

>> YOU ALLUDED TO THAT YOU WANT PEOPLE COMING BACK IN.

>> YES.

>> SO TYPICALLY HOW OFTEN DOES A PATIENT COME IN AND DOES THAT KIND OF PUSH BACK-- IF YOU HAVE 750 PEOPLE THAT YOU ARE CARING, DOES THAT PUSH BACK AND KEEP SOMEONE ELSE FROM GETTING IN?

>> NO, I DON'T THINK SO.

I THINK WE HAVE BEEN ABLE TO ACCOMMODATE THE PATIENTS WE NEED TO SEE.

I WOULD SAY THAT ONE OF THE THINGS THAT YOU DO WANT TO DO AS A PHYSICIAN, WE ALL KNOW OUR PATIENTS, AND YOU KNOW WHO MAY NEED A LITTLE MORE, AND YOU KNOW THOSE WHO ARE DOING REALLY WELL.

MAY NOT NEED YOU AS MUCH.

WE TEND TO SAY WE LIKE TO SEE PATIENTS EVERY QUARTER ON AVERAGE.

BUT THERE ARE PATIENTS WHO, YOU MAY NOT NEED TO SEE EVERY QUARTER.

THERE ARE PATIENTS YOU MAY NEED TO SEE MORE OFTEN THAN THAT SO WE WANT TO ALLOW FOR THAT BALANCE SO WE CAN SEE PATIENTS AS WELL AS FIND OTHER MODALITIES TO INCORPORATE THOSE VISITS WERE WHETHER IT'S VIRTUAL, TELEPHONE IB, IF YOU HAVE TO.

>> I WAS GOING TO ASK YOU ABOUT THAT.

WHAT IS THE ROLE OF TELEMEDICINE IN YOUR PRACTICE AND DO YOU UTILIZE IT AS ONE OF YOUR PRIMARY METHODS OF CONTACTING PATIENTS?

>> I WON'T SAY IT'S NOT PRIMARY.

IT'S DEFINITELY MODALITY THAT WE DO UTILIZE.

I THINK AFTER, YOU KNOW, AFTER THE PANDEMIC AND EVERYBODY CAME BACK OUT, WE WERE ALL ANXIOUS TO BE IN FRONT OF EACH OTHER.

AND SO YOU SAW TELEHEALTH KIND OF TAKE A DIVE DOWN FOR A WHILE.

AND NOW I'M SEEING IT FIND MORE OF A RESTING KIND OF A RESTING STAGE AT THIS POINT WHERE I THINK PATIENTS ARE WILLING TO ENTERTAIN IT BECAUSE IT'S A TIME SAVER FOR THEM.

THEY DON'T HAVE TO GET UP, GET DRESSED, LEAVE THE HOUSE, COME TO SEE YOU.

FOR PROVIDERS, IT ENABLES US TO HAVE THE TOUCH POINT WITH PATIENTS, BE ABLE TO STILL SEE THEM FACE TO FACE THROUGH A VIDEO.

AND STILL GET QUALITY OUTCOMES FROM THAT.

SO TO ME, IT'S ANOTHER TOOL IN THE TOOL BELT.

>> YOU DON'T HAVE SPECIALISTS WITHIN THE SYSTEM ITSELF.

>> RIGHT.

>> SO YOU OBVIOUSLY HAVE TO COMMUNICATE WITH SPECIALISTS.

ARE YOU LOCKED INTO ANY ONE SYSTEM AND HOW DO YOU KEEP IN CONTACT WITH THEM?

>> WE ARE NOT LOCKED IN OR AFFILIATED WITH ANY ONE PARTICULAR SYSTEM.

WE HAVE ON OUR TEAM AS WELL, REFERRAL SPECIALISTS WHO HELP US WITH REFERRAL MANAGEMENT.

WE ALSO HAVE A MEDICAL RECORDS COORDINATOR WHO HELPS TO OBTAIN THE MEDICAL RECORDS THAT WE FEED-- THAT WE NEED, THE INFORMATION SO THE NURSE PRACTITIONERS AND DOCTORS HAVE THE INFORMATION PRIOR TO THE VISIT.

WE FIND THAT HAVING THOSE ROLES HELPS THE COMMUNICATION WITH THE SPECIALIST.

I WOULD GO BACK AND SAY THAT HAVING STRONG PRIMARY CARE IS REALLY THE GOAL.

I THINK MOST INTERNISTS, FAMILY PRACTITIONERS CAN HANDLE MOST DISEASES, DISEASE CONDITIONS.

I THINK THAT DUE TO LACK OF TIME, WHAT IS HAPPENED IS THAT WE HAVE STARTED REFERRING, RIGHT?

I DON'T HAVE TIME TO DO THIS THE WAY I KNOW HOW TO DO AND I KNOW I COULD DO IT, I COULD DO IT WELL BUT I DON'T HAVE TIME AND SO I'M GOING TO REFER IT TO SOMEONE.

AND WHAT WE HAVE DONE AT CENTER WELL IS TO SAY HEY, WE WANT TO BE VERY STRONG IN PRIMARY CARE AND WE WILL REFER WHEN WE ABSOLUTELY NEED TO.

BUT I THINK FOR SENIORS, A REFERRAL IS YET ANOTHER PLACE TO TRAVEL, ANOTHER POINT OF TRAVEL.

AND AS YOU GET OLDER, IT'S NOT EASY AND THE HEALTH SYSTEM IS SO COMPLICATED TO ADD ANOTHER PHYSICIAN ADDS ANOTHER LAYER OF COMPLEXITY.

>> I'M GOING TO ASSUME THE ANSWER NO IS NO, BUT YOU DON'T LOSE FUNDING IF YOU REFER SOMEONE OUT TO ANOTHER PHYSICIAN?

>> NO, SIR.

>> SO IT'S NOT THAT YOU ARE GIVING A CERTAIN NUMBER OF DOLLARS TO MANAGE THIS PERSON'S CARE AND THAT ANY DOLLAR GOES OUT IS LESS THAT STAYS IN?

>> ONCE AGAIN IT GETS BACK TO THE CONTRACT PIECE.

IF YOU ARE ASSUMING WHAT IS CALLED GLOBAL RISK FOR A PATIENT, THEN YES, YOU WOULD BE ALLOTTED A CERTAIN AMOUNT OF MONEY SO IF YOU DO, WHEREVER YOU SPEND IT, DOESN'T MATTER IF IT'S REFERRAL OR ANYTHING ELSE OR HOWEVER YOU SPEND IT, COMES OUT OF THE POOL.

SO YES, THE ANSWER TO THAT WOULD BE YES; HOWEVER, YOU KNOW, IF SOMEONE NEEDS TO BE REFERRED THEY NEED TO BE REFERRED.

>> HOW DOES YOUR CONCEPT OF CARE DIFFER FROM SEEING THE GERONTOLOGIST?

>> I DON'T KNOW THAT IT TRULY DOES.

IT'S VERY MUCH SENIOR FOCUSED.

IT'S VERY MUCH ABOUT GERIATRICS AND GERIATRICS TO ME IS WHAT MATTERS THE MOST TO THE PATIENT, LOOKING AT MEDICATIONS, LOOKING AT MOBILITY AND FUNCTIONALITY, WHICH WE DO ON EVERYBODY.

AND ADVANCE CARE PLANNING.

SO, OF COURSE, JERIATIANS ARE HAVE MORE INFORMATION.

BUT WE HAVE A LOT ON STAFF.

>> THE MODEL THAT YOU HAVE CREATED, I'M SURE OTHERS HAVE SEEN IT AND ARE DOING IT THEMSELVES.

IS THIS SOMETHING THAT IS GROWING RIGHT NOW IN THE COUNTRY OR EVEN IN THIS AREA.

>> VALUE-BASED CARE?

YES, IT IS.

IT HAS BEEN GROWING FOR QUITE A WHILE NOW.

SO SEEING IT PICK UP STEAM.

>> IS IT EASIER TO DO FOR THE SENIOR PATIENT OPPOSED TO FOR THE UNDER 65 YET SET.

>> AS OF RIGHT NOW IT IS.

>> THAT'S BECAUSE THOSE OF US OVER 65, NOT INCLUDING YOU, SPEAKING ABOUT ME BECAUSE WE ARE MORE COOPERATIVE AND BEHAVE ABOUTERT.

>> I THINK IT'S ABOUT MEDICARE.

>> COMES DOWN TO INSURANCE ISSUES.

AMAZING, ISN'T IT?

>> I KNOW.

>> SO, HOW DOES SOMEBODY GET INTO THIS?

IN TERMS OF A PATIENT.

I'M SITTING THERE SAYING I LIKE THAT IDEA.

>> NO, WE WELCOME ANYONE TO COME INTO ANY OF OUR CENTERS.

WE HAVE THREE IN THE LOUISVILLE AREA.

OUR LATEST ONE IS AT 30th AND MARKET, THE WEST LOUISVILLE CENTER WHICH HAD A GRAND OPENING ABOUT A WEEK OR SO AGO.

WE HAVE ONE AT SOUTH SECOND STREET NEAR CHURCHILL DOWNS AND ANOTHER ONE OUTER LOOP ACROSS FROM THE JEFFERSON MALL.

>> GIVE ME IF YOU WOULD IN THE NEXT 30 SECONDS, THREE TAKE HOME POINTS WE SHOULD KNOW.

>> SENIORS DESERVE TO HAVE GREAT CARE.

YOU DESERVE TO BE TREATED LIKE FAMILY WHEN YOU COME IN THE DOOR.

AND YOU DESERVE TO HAVE TIME FOR SOMEONE TO LISTEN TO YOU.

>> I THINK THIS IS A GREAT CONCEPT AND I REALLY APPLAUD YOU FOR BEING AHEAD OF THE CURVE ON THIS BECAUSE QUITE FRANKLY, WE ALL WANT TO GO SOMEWHERE WHERE SOMEONE KNOWS US AND WE KNOW WE ARE GOING TO BE TREATED VERY NICELY IF NOT FOR ME, THEN SURELY FOR MY FAMILY.

SO THANK YOU FOR BEING WITH US TODAY.

>> THANK YOU.

>> ALSO LIKE TO THANK YOU FOR BEING WITH US TODAY.

YOU KNOW, THERE ARE MANY WAYS IN WHICH HEALTHCARE MAY BE DELIVERED.

THE TRICK IS TO FIND THE ONE THAT SUITS THE NEEDS OF YOU AND/OR YOUR LOVED ONES.

MORE CARE IS NOT NECESSARILY BETTER CARE.

BUT WHAT IS IMPORTANT IS TO GET WHAT YOU NEED AND GET IT IN A TIMELY FASHION.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN AR I'VEED VERSION OF-- ARCHIVED VERSION OF PAST SHOWS, GO TO KET.ORG/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KY HEALTH AT ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH" AND I HOPE IN THE MEANTIME WILL YOU INVESTIGATE DIFFERENT WAYS OF GETTING CARE.

TALK TO YOUR PRIMARY CARE PROVIDER RIGHT NOW AND ASK THEM WHAT YOU CAN DO.

IF YOU ARE NOT HAPPY, SEEK OUT SOME OTHER CARE WHERE PEOPLE TAKE TIME TO TALK TO YOU BECAUSE I THINK THAT'S THE BIGGEST THING THAT WE ALL WANT, TO SIT DOWN AND TALK TO OUR DOCS.

AGAIN, LOOK FORWARD TO TALKING TO YOU AGAIN NEXT WEEK AND THANK YOU VERY MUCH FOR BEING WITH US TODAY.